Universität zu Köln

Kaasch, Achim J., Kern, Winfried, V, Joost, Insa, Hellmich, Martin, Seifert, Harald and Rieg, Siegbert (2019). Effect of Clinically Uninfected Orthopedic Implants and Pacemakers/AICDs in Low-Risk Staphylococcus aureus Bloodstream Infection on Crude Mortality Rate: A Post Hoc Analysis of a Large Cohort Study. Open Forum Infect. Dis., 6 (5). CARY: OXFORD UNIV PRESS INC. ISSN 2328-8957

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Abstract

Background. The standard treatment duration in low-risk Staphylococcus aureus bloodstream (SAB) is 14 days. However, it is unclear whether an extended course of antimicrobial therapy is necessary in patients with clinically uninfected prosthetic joints/osteosyntheses or pacemakers/automated implanted cardioverter-defibrillators (AICDs). Thus, we compared the duration of antimicrobial therapy and outcomes in patients with and those without clinically uninfected foreign bodies. Methods. We conducted a post hoc analysis of data from the prospective Invasive Staphylococcus aureus Infection Cohort (INSTINCT) study. Adult low-risk patients who survived >= 4 days were assessed for duration of treatment, SAB-related events (attributable death, relapse, or new deep-seated infection), and survival. Results. Of the 1288 patients enrolled, 292 satisfied criteria for low-risk SAB. Forty-three patients (15%) had a clinically uninfected pacemaker/AICD or orthopedic implant. Patients with foreign bodies were significantly older (mean age, 72 vs 62 years for those without; P < .001; P = .9) and had a higher Charlson score (median, 3 vs 2; P = .06). The total duration of antimicrobial therapy (median, 18 vs 17 days, respectively; P = .7), all-cause mortality rate (16% vs 14%; P = .7), and prevalence of SAB-related events within 90 days were similar (2% vs 2%) in the 2 groups. At 1-year follow-up, SAB-related events were more frequent in patients with foreign bodies (7% vs 4% in those without; P = .4) (hazard ratio, 1.41; 95% confidence interval, .35-5.69; in a multivariable Cox model), but this difference was not statistically significant. Conclusions. Low-risk patients with clinically uninfected foreign bodies received a similar duration of antimicrobial therapy without a significant impact on mortality rate. The observed higher hazard ratio of SAB-related events within 1 year necessitates additional studies before recommendations concerning treatment duration in this patient subgroup can be adapted or modified.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Kaasch, Achim J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kern, Winfried, V UNSPECIFIED UNSPECIFIED UNSPECIFIED Joost, Insa UNSPECIFIED UNSPECIFIED UNSPECIFIED Hellmich, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Seifert, Harald UNSPECIFIED UNSPECIFIED UNSPECIFIED Rieg, Siegbert UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-148681
DOI:	10.1093/ofid/ofz170
Journal or Publication Title:	Open Forum Infect. Dis.
Volume:	6
Number:	5
Date:	2019
Publisher:	OXFORD UNIV PRESS INC
Place of Publication:	CARY
ISSN:	2328-8957
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PRACTICE GUIDELINES; DISEASES SOCIETY; BACTEREMIA; MANAGEMENT; ADULTS; CARE; AMERICA Multiple languages Immunology; Infectious Diseases; Microbiology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/14868